Patients with abnormal vaginal bleeding require ultrasound imaging. Consider obtaining a CT scan if a pelvic mass is suspected.

Cervical cancer screening is required preoperatively.

The route of surgery depends on the indication for trachelectomy, surgeon’s experience and comfort, the presence of comorbidities, and the need for concomitant procedures. The preoperative planning for a vaginal trachelectomy begins with a thorough history and physical examination. The surgeon should pay particular attention to the degree of prolapse, the presence of a pelvic mass, adnexal tenderness, and whether the cervix is mobile. A laparoscopic approach should be considered if the patient has unexplained pelvic pain or suspected endometriosis, or if there is an adnexal/pelvic mass requiring removal. Counseling should include the risk of conversion to laparotomy, independent of a minimally invasive approach.

Confirm the patient’s cervical cancer screening is up-to-date.

Patients with significant medical comorbidities should also undergo preoperative clearance.

Perform thorough counseling and discuss the risks, benefits, alternative, and different routes of surgery. Obtain a signed, informed consent.

The most common indications for trachelectomy are pelvic organ prolapse, pelvic mass, abnormal cytology, bleeding, and pain. Trachelectomy is a relatively safe and effective procedure. Patients should be counseled on the risk of bleeding and injury to the urinary tract or bowel.